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The author, who's considerable personal experience is based on 411 cases of hypospadias in children operated at the Mayo Clinic (Rochester, Minnesota, U.S.A.), emphasizes: 1 The importance of a strict assessment of results, considering not only fistulas and apparent cosmetic results, but also stenoses of urethroplasty, sacculations, meatic stenoses and stricture, and insufficient correction of the penile curve. 2 The capacity to choose, in each particular case, between several procedures. 3 The unquestionable security offered by correction in three separate stages: straightening of the penis, urethroplasty by burrowing in the scrotum then resurfacing. 4 The difficulty of re-operation which leads to 60% of complications and needs several surgical stages. In short, you can't improvise the treatment of hypospadias.

Of 49 children with renal ectopy, 25 (51%) had hydronephrosis on excretory urography. Dilatation of the renal pelvis was the result of primary ureteropelvic junction obstruction (17 children), significant vesicoureteral reflux (6 children), or extrarenal pelves and calices with renal malrotation producing apparent ureteropelvic junction obstruction (2 children). Vesicoureteral reflux was a common finding in these patients, occurring in 52% of those with crossed renal ectopy and in 70% of those with pelvic kidney. The need for surgical intervention results from either (1) ureteropelvic junction obstruction secondary to high insertion of the ureter on the renal pelvis or (2) vesicoureteral reflux secondary to aberrant migration of the lower ureter. Most children with renal ectopy and ureteropelvic dilatation require surgical reconstruction at the renal level. In selected patients, ureterocalicostomy is an attractive alternative to conventional pyeloplasty and appears to afford improved drainage with superior results.